Do Performance Measures of Strength, Balance, and Mobility Predict Quality of Life and Community Reintegration After Stroke?

Cohen, Joshua W.; Ivanova, Tanya D.; Brouwer, Brenda; Miller, Kimberly J.; Bryant, Dianne; Garland, S. Jayne

doi:10.1016/j.apmr.2017.12.007

Cited by 49 publications

(29 citation statements)

References 40 publications

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“…Functional impairment post-stroke underlies loss of selective joint control and muscle weakness. From a clinical perspective, both issues must be addressed via safe, comfortable and feasible positions for the patient [61, 62], something that could be provided by our proposed framework. Future work will pair wearable exoskeletons with our model-based human-machine interface to track and support the patient across all recovery stages: from sitting to walking in the hospital to finally walking outside the hospital [63].…”

Section: Discussionmentioning

confidence: 99%

Voluntary control of wearable robotic exoskeletons by patients with paresis via neuromechanical modeling

Durandau

Farina

Asín-Prieto

et al. 2019

J NeuroEngineering Rehabil

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Background: Research efforts in neurorehabilitation technologies have been directed towards creating robotic exoskeletons to restore motor function in impaired individuals. However, despite advances in mechatronics and bioelectrical signal processing, current robotic exoskeletons have had only modest clinical impact. A major limitation is the inability to enable exoskeleton voluntary control in neurologically impaired individuals. This hinders the possibility of optimally inducing the activity-driven neuroplastic changes that are required for recovery. Methods: We have developed a patient-specific computational model of the human musculoskeletal system controlled via neural surrogates, i.e., electromyography-derived neural activations to muscles. The electromyography-driven musculoskeletal model was synthesized into a human-machine interface (HMI) that enabled poststroke and incomplete spinal cord injury patients to voluntarily control multiple joints in a multifunctional robotic exoskeleton in real time. Results: We demonstrated patients' control accuracy across a wide range of lower-extremity motor tasks. Remarkably, an increased level of exoskeleton assistance always resulted in a reduction in both amplitude and variability in muscle activations as well as in the mechanical moments required to perform a motor task. Since small discrepancies in onset time between human limb movement and that of the parallel exoskeleton would potentially increase human neuromuscular effort, these results demonstrate that the developed HMI precisely synchronizes the device actuation with residual voluntary muscle contraction capacity in neurologically impaired patients. Conclusions: Continuous voluntary control of robotic exoskeletons (i.e. event-free and task-independent) has never been demonstrated before in populations with paretic and spastic-like muscle activity, such as those investigated in this study. Our proposed methodology may open new avenues for harnessing residual neuromuscular function in neurologically impaired individuals via symbiotic wearable robots.

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Section: Discussionmentioning

confidence: 99%

Voluntary control of wearable robotic exoskeletons by patients with paresis via neuromechanical modeling

Durandau

Farina

Asín-Prieto

et al. 2019

J NeuroEngineering Rehabil

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“…Increase in the aging population and the adoption of a westernized diet are leading to a rise in the incidence of stroke every year 1. The ability to walk independently around the home and in the community is important for people after stroke because it enables participation in social and domestic roles and promotes quality of life 2,3. Although it is estimated that 85% of people can walk independently 6 months post-stroke,2 only a small proportion achieve normative levels of walking ability 3–5.…”

Section: Introductionmentioning

confidence: 99%

<p>Kinematic on Ankle and Knee Joint of Post-Stroke Elderly Patients by Wearing Newly Elastic Band-Type Ankle–Foot Orthosis in Gait</p>

Kim¹,

Won²

2019

CIA

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PurposeThe post-stroke elderly was increased caused by increasing stroke and advanced medical. However, ankle–foot orthoses (AFOs) can be uncomfortable for hemiplegic patients; therefore, the usability is not good. In this study, we analyzed ankle and knee joint angles in post-stroke elderly patients to assess the functional effectiveness (specifically prevention of back knee and drop-foot) of a new elastic band-type AFO (New Product: NP) during gait.Patients and methodsNine elderly post-stroke patients (eight males, one female; 55.7±8.4 years; 165.8±9.2 cm; 68.8±11.5 kg; five with right hemiplegia, four with left hemiplegia; onset period: 6.6 years) were selected for participation in this study. We captured gait motion using 12 cameras (MX-T20, Vicon, Inc., Oxford, UK) under three different conditions [wearing nothing (WI), using existing ordinary AFOs made from hard plastic material (EP), and using NP]. The angle variation and maximum–minimum angle of the lower body joints were analyzed during dorsi-plantar flexion of the ankle joint and flexion–extension of knee joint. A one-way ANOVA test for multiple comparisons was performed, followed by a Tukey’s b test to identify statistical significance, which was set at 0.005.ResultsRegarding the ankle joint, the maximum plantar flexion (drop-foot) value decreased with the NP, and the maximum dorsiflexion value increased. Regarding the knee joint, the maximum extension (back knee) value decreased, and the maximum flexion value increased (p < 0.005).ConclusionUsing analysis of the kinematics of the ankles and knees during walking, this research confirmed the effectiveness of the NP, an elastic band-type AFO, for use in ordinary post-stroke elderly patients.

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“…The maximum scores obtained from 36 questions where 149 which represents best QOL whereas minimum score 36 represents the worst [23]. The scale was used earlier in acute stroke patients [24,25].…”

Section: Outcome Variablesmentioning

confidence: 99%

Comparison between Erigo tilt-table exercise and conventional physiotherapy exercises in acute stroke patients: a randomized trial

2020

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Background: Stroke is a common, serious, and disabling health-care problem throughout the world. Although great advances have been made in acute stroke management, the most of post-stroke care to reduce a patient's dependency relies on rehabilitation.Purpose: To compare the effectiveness of exercises using an Erigo tilt-table and conventional physiotherapy in the rehabilitation of acute stroke patients.Methods: A total of 110 acute stroke patients (age 51.08 ± 7.48 years, 8.69 ± 4.62 days after stroke) were assigned randomly into two groups, 55 in each for 30 days of conventional physiotherapy (Group A) or Erigo tilt-table (Group B) rehabilitation. The National Institutes of Health Stroke Scale (NIHSS), Mini-Mental Scale Examination (MMSE), Modified Ashworth Scale were used to measure muscle tone, quality of life (QOL) and muscle strength (MMT), Affected upper (UE) and lower limb (LE) outcomes were assessed at baseline (day 0), after day 30 of the intervention and on 90th day of follow up. Repeated measures ANOVA followed by a Bonferroni post-hoc test and independent Student's t-test were used for statistical analysis to evaluate the improvement in outcome variables within and between the groups. Results: Both the treatments were effective. Notably, Group B patients showed a significant improvement in both QOL (p < 0.001) and lower limb strength (p = 0.030) at day 90 and muscle tone (p = 0.011) at day 30 compared to Group A. Conclusion: Both the groups improved with time but the Erigo tilt-table group experienced greater improvement in QOL, NIHSS and muscle strength of the lower limb. Thus, Erigo tilt-table can be used for early rehabilitation of acute hemiplegic patients and improving their quality of life and motor system, resulting in better functional performances.

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Do Performance Measures of Strength, Balance, and Mobility Predict Quality of Life and Community Reintegration After Stroke?

Cited by 49 publications

References 40 publications

Voluntary control of wearable robotic exoskeletons by patients with paresis via neuromechanical modeling

Voluntary control of wearable robotic exoskeletons by patients with paresis via neuromechanical modeling

<p>Kinematic on Ankle and Knee Joint of Post-Stroke Elderly Patients by Wearing Newly Elastic Band-Type Ankle–Foot Orthosis in Gait</p>

Comparison between Erigo tilt-table exercise and conventional physiotherapy exercises in acute stroke patients: a randomized trial

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